Surgical vs. Conservative Management of Chronic Sciatica (>3 Months) Due to Lumbar Disc Herniation: Systematic Review and Meta-Analysis.

Sciatica, characterized by leg or back symptoms along the sciatic nerve pathway, often manifests as a chronic condition lasting over 12 weeks. Decision-making between nonoperative treatment and immediate microdiscectomy for chronic sciatica remains challenging, due to the complex relationship between symptom duration, severity, and lumbar discectomy outcomes. In this systematic review, we conducted a comprehensive search across Scopus, PubMed, Web of Science, and the Cochrane Library, identifying relevant two-arm clinical trials up to September 2023. Rigorous screening and data extraction were performed by two independent reviewers, with study quality evaluated using the risk of bias 2 (RoB) tool. This meta-analysis incorporated four studies comprising 352 participants. Our analysis revealed that conservative treatment was associated with a significant reduction in leg pain and improvement in, SF mental, and physical scores compared to surgical intervention. However surgical treatment demonstrated significant improvement in back pain. In conclusion, our findings suggest that surgical intervention may be more effective than non-surgical treatment for chronic sciatica-related back pain. Conservative treatment significantly reduces leg pain while improving mental and physical health outcomes. Ultimately, our findings support conservative as the initial approach unless surgery is warranted, particularly in cases with neurological deficits or cauda equina syndrome.

Effectiveness of unilateral percutaneous vertebroplasty for acute traumatic non-osteoporotic compression vertebral fractures.

Although vertebroplasty is a well-known treatment for osteoporotic and neoplastic compression fractures, there is limited evidence to support its use in traumatic compression fractures without osteoporotic degeneration. The purpose of this study was to evaluate the correlation of kyphosis and wedge angles with pain relief and functional outcome after percutaneous vertebroplasty. 38 patients who harbored acute traumatic non-osteoporotic compression vertebral fractures without neurological complications refractory to at least 5 days of conservative treatment were included in this study. Follow-up evaluations included pain (assessed with the visual analog scale) and medication use. Functional outcome was measured using Oswestry low back pain disability questionnaire. Cobb angles, Gardner angles and kyphotic angles were measured on the full-spine radiographs preoperatively and postoperatively. The axial pain visual analog scale score (8.05 ±â€…1.23 pre-op vs 1.18 ±â€…1.09 post-op, P < .05) and The Oswestry low back pain disability questionnaire score (33.45 ±â€…6.97 pre-op vs 4.47 ±â€…2.41 post-op, P < .05). The Cobb's angle (19.66° ± 8.68° pre-op vs 15.08° ± 7.51° post-op, P < .05), the Gardner's angle (17.72° ± 6.52° pre-op vs 14.13° ± 7.13° post-op, P < .05) and the kyphotic angle (17.51° ± 5.8° pre-op vs 8.81° ± 4.14°post-op, P < .05) were significantly reduced postoperatively therefore, local kyphosis was markedly restored after vertebroplasty. Our findings show that vertebroplasty for patients with traumatic spinal compression fractures reduces pain, improves mobility, reduces the need for painkillers, and significantly affects kyphotic angles.

Tetraparesis as an initial manifestation of biotinidase deficiency: a case report.

Biotinidase deficiency (BTD) is an autosomal recessive disorder and causes the deficiency of four biotin-containing carboxylases. The prevalence is estimated at 1 in 60 000 births. BTD is associated with a wide spectrum of clinical manifestations, including abnormalities of the neurological, dermatological, immunological, and ophthalmological systems. Spinal cord demyelination as a manifestation of BTD has been infrequently described. Case presentation: The authors present a case of 2.5-year-old boy complained of progressive weakness in all four limbs, with difficulties in breathing. Clinical discussion: Abdominal examination revealed hepatomegaly and splenomegaly. Also, her parents were first-degree cousins. Therefore, tandem mass spectroscopy and urine organic acid analysis were planned to exclude metabolic disorders. Urinary organic acid analysis revealed elevated levels of methylmalonic acid and 3-hydroxyisovaleric acid. Serum biotinidase activity was found to be 3.9 nmol/min/ml. Oral biotin at a dose of 1 mg/kg daily was initiated. A marked improvement of his neurological deficit was noted over a period of 15 days after treatment and cutaneous manifestations resolved within 3 weeks. Conclusion: Myelopathy due to BTD is a challenging diagnosis. Spinal cord impairment is a rare complication of this disease and is frequently unrecognized. BTD should be included in the differential diagnosis of children presenting with demyelinating spinal cord disease.

Lethargy and quadraparesis as initial manifestations of covid-19 child: Case report.

Introduction: and importance: SARS-CoV-2 infection classically presents with fever and respiratory illness. However, neurological manifestations are also being reported in the literature. Transverse myelitis is caused by inflammation of spinal cord. There are various possible etiologies for this neurologic condition that include viral or bacterial infections. Case presentation: We present a case of 2 -year-old female complained of weakness of all four limbs and lethargy.She was febrile(39), respiratory rate 30/min and oxygensaturation of 89% on room air. Neurological examination revealed intact cranial nerves, GCS of 14/15 and upper and lower limbs weakness with medical research council(MRC) score of 2/5 Sensory examination showed decreased sensation of all modalities in lower limbs with a sensory level at T4. Clinical discussion: Laboratory results and cerebrospinal fluid (CSF) analysis showed normal values. Brain MRI was normal. An urgent Gadolinium-enhanced magnetic resonance imaging of the whole spine was done and revealed extensive diffuse hyper intense signal involving predominantly the grey matter of the upper cervical spinal cord. Mild enlargement and swelling of the cervical cord were also note. She was given pulse doses of IV methylprednisolone 30mg/kg followed by oral prednisolone for 40 days. She was also given IV gamma globulin 400mg/kg for five days. A marked improvement of his neurological deficit was noted over a period of 16 days after treatment. Conclusion: when a patient with myelopathy is systemically ill with fever andloss of consciousness, prompt investigation of the causative agent is needed for appropriate management. Even after the pandemic Status; COVID-19 should be considered a differential diagnosis in patients presenting with loss of consciousness, ataxia, convulsions, motor deficits, encephalitis, myelitis, or neuritis.

Cerebral venous sinus thrombosis as a complication of primary varicella infection in a child, case report.

INTRODUCTION AND IMPORTANCE: Chickenpox (Varicella) is a benign illness caused by varicella-zoster virus, predominant in childhood.Chicken pox related neurological complications are seen in less than 1% cases of chickenpox.Cerebral Venous thrombosis due to primary (VZV) infection is very rare, and it may occurs secondary to primary or re-activation the virus. CASE PRESENTATION: We report a case of 5-year-old female complained of ataxia, vomiting, headache, and drowsiness 7 days after the onset varicella zoster infection. She had vesicular lesions with scab over the trunk and limbs. CLINICAL DISCUSSION: Neurological examination revealed left hemiparesis.Her blood counts and metabolic parameters were normal.Computed tomography brain showed hemorrhagic infarct in the left temporo-parietal region. Coagulation profile was normal. Magnetic resonance imaging (MRI) brain revealed hemorrhagic infarct in the same region. Magnetic resonance Venogram showed thrombosis of left transverse sinus and sigmoid sinus and internal jugular vein.VZV- IgG antibody was positive but CSF VZV PCR (Polymerase chain reaction) was found to be negative.Intravenous acyclovir for 15 days, and low-molecular-weight heparin for 3 days overlapped with oral Warfarin for 3months,. After 3 months follow up, the patient experienced a complete recovery. MRI repeated after 3 months showed recanalization of the sinuses. CONCLUSION: The pathogenic link of occurrence of CSVT after VZV infection is unclear, but some articles showed that it is related to direct endothelial damage by the virus.Early recognition of this complication of VZV infection and prompt treatment is essential to prevent catastrophic complications.

Lethargy as an initial symptom of intussusception secondary to Meckel's diverticulum in a 2.5 year-old girl: Case report.

INTRODUCTION: and importance: Intussusception is one of the most common causes of acute abdomen and surgical morbidities in the childhood. In a paediatric presentation of intussusception due to Meckel's diverticulum there may be acute onset of abdominal pain, vomiting or painless red currant stools. However, Lethargy has been described as a rare presenting symptom. CASE PRESENTATION: We present a case of 2,5 - year old female complained of acute alternation in consciousness followed by continuous vomiting two days later. CLINICAL DISCUSSION: Her neurological examination showed a lethargic child, not reactive and hypotonic. Her past medical history was unremarkable. Abdominal ultrasonography was compatible with ileocolic intussusception. The necrotic bowel and diverticulum were resected, followed by anastomosis of the viable bowel segments. postoperatively the infant recovered dramatically. CONCLUSION: Although lethargy is a rare presenting symptom of Intussusception, it should be kept as a differential diagnosis when a child presents with acute onset of drowsiness with or without abdominal symptoms.

Diagnosis and treatment of Rasmussen's encephalitis pose a big challenge: Two case reports and literature review.

Rasmussen encephalitis (RE) is a rare disease of unknown etiology that causes severe chronic unihemispheric inflammatory disease of the central nervous system mainly in children. It leads to intractable seizures, cognitive decline and progressive neurological deficits in the affected hemisphere. We report two cases of RE, as defined by fulfillment of the 2005 Bien criteria. The diagnostic challenge of characterizing this rare disease will be highlighted by the extensive serum, CSF, MR imaging and EEG data in the two patients. In addition, we will review the various forms of therapy attempted in these two patients, namely anti-epileptic drug therapy and immunomodulatory therapy. Hemispherectomy was done for the second patient with favorable outcomes of controlling seizures, but unfortunately, he died because of meningitis. Until the causes of Rasmussen's encephalitis are known, it is difficult to anticipate how treatments will improve. Such a situation creates a therapeutic dilemma; hemispherectomy is not favored because of the inevitable postoperative functional deficits, but a real risk exists that treatments used to delay progression of the disease will defer definitive surgical treatment beyond the time when an optimum post-hemispherectomy outcome could be expected.

A rare case of congenital cystic adenomatoid malformation: Mimics pneumonia manifestations.

INTRODUCTION AND IMPORTANCE: Congenital cystic adenomatoid malformation (CCAM) is a rare malformation, with unknown causes, that affects distal bronchi. It accounts for 25% of congenital pulmonary malformation s and most cases are found in neonates and babies.The mortality rate of prenatally diagnosed cases ranges from 9 to 49%. The risk factors for poor outcome include hydropsfoetalis, microcystic CCAM and the overall size of the lesions.The mainstay of CCAM treatment is surgical excision that prevents complications such as recurrent infections, pneumothorax and malignancy. CASE PRESENTATION: Our case is a 4-month-old boy born presented with shortness of breath and poor suckling. He was admitted to intensive care for respiratory distress. CLINICAL DISCUSSION: A working diagnosis of pneumonia was entertained and the patient given humidified oxygen through nasal prongs, intravenous fluids and antibiotics.Thoracic CT showed a cystic malformation in the left lower lung lobe.Due to continuing recurrent infections and the risk of rupturing of the cyst with subsequent pneumothorax, it was decided to proceed with a left lower lobectomy.The post-operative course was uneventful and the patient was discharged home on the fifth post-operative day. CONCLUSION: Congenital cystic adenomatoid malformation should be a differential diagnosis of pneumonia.A real awareness of this rare entity among pediatricians and radiologists should allow early diagnosis and proper treatment.

Pure posterior chordoid foramen magnum meningioma: A case report and review of literature.

INTRODUCTION AND IMPORTANCE: Meningiomas are extra-axial central nervous system (CNS) tumors that arise from the arachnoid cells of the dura mater. Only 1.8-3.2% of all meningiomas are located at foramen magnum (FM) and pure posterior FM meningioma are very rare. The diagnosis of malignancy in patients with meningiomas has been a controversial issue. Only a histological study can confirm this situation. CASE PRESENTATION: We report a case of A 52-year-old female presented with a history of neck pain with progressive spastic quadriparesis. CLINICAL DISCUSSION: Magnetic resonance imaging MRI T1 and T2 weighted images revealed well-defied pure posterior foramen magnum Lesion. Although the lesion was very sticky to neurovascular components. Simpson grade I was achieved. Histopathology revealed Chordoid meningioma. The patient had a dramatic recovery. CONCLUSION: Although choroid meningioma is usually well circumscribed, sticky tumors should be suspected. Recurrence of Chordoid meningioma should be suspected. Total excision should be achieved and routine follow-up should be informed. Reports about chordoid meningioma aren't common, but reports on choroid foramen magnum meningioma are very rare. The opportunity to give the patient a symptom-free and normal life should not be missed in such cases.

Complete resection of pure anterior foramen magnum meningioma without neurovascular injuries poses a big challenge: Case report.

INTRODUCTION AND IMPORTANCE: Meningiomas are common neoplasms representing 14.3-19% of all intracranial tumors. Among all the meningiomas, only 1.8-3.2% arises at the foramen magnum (FM) level.Most of the lesions (68%-98%) arising anterolaterally, followed by postolateral, purely posterior and, more rarely, purely anterior. CASE PRESENTATION: We report a case of A 42-year-old female presented with a history of neck pain with progressive spastic hemiparesis. CLINICAL DISCUSSION: MRI revealed well-defied pure anterior and on both sides of vertebral artery, foramen magnum lesion. Through conservative transcondylar approach, Lesion was removed totally in a piecemeal fashion. Histopathology revealed meningothelial meningioma. The patient had a dramatic recovery. CONCLUSION: The exposure allowed by the far-lateral retrocondylar or partial transcondylar approach is adequate for resecting even anterior intradural FMMs.Reports about Foramen magnum meningioma aren't common, but reports on pure anterior foramen magnum meningioma are very rare. The prerequisite for treating FM meningiomas (FMMs) is the perfect knowledge of the surgical anatomy. The opportunity to give the patient a symptom-free and normal life should not be missed in such cases.

Spontaneous migration of a falling bullet in the cerebellum reveals the importance of intraoperative skull X-ray.

Cranial gunshot wounds (CGSWs) are the most lethal types of the cranial traumas and they are usually mortal. Falling bullets or gravitational bullets are the ones that move under the effect of the gravity force after the muzzle force diminished. CGSWs constitute a major clinical challenge for neurosurgeons dealing with trauma in both the military and civil experience. We report the case of a 21-year-old man with a falling bullet wound to the head. The decision of surgical treatment of a bullet injury is difficult if it is in close proximity to vital structures; removal of the bullet may cause significant neurological damage; however, migration can lead to a worsening of the neurological status of the patient. Before surgical removal of any intracranial bullet, as valuable information, it is recommended that a plain skull X-ray be obtained after final positioning of the head.

Complete resection of a huge parapharyngeal lesion without neurovascular injuries poses a big challenge.

Pleomorphic adenoma is the most common salivary gland neoplasm, accounting for 63% of all parotid gland tumors. Most tumors originate in the superficial lobe but, more rarely, these tumors may involve the deep lobe of the parotid gland, growing medially and occupying the parapharyngeal space (PPS). Our case presents a 48-year-old man with an extremely huge recurrent parapharyngeal lesion that bulging in the nasopharynx and the oropharynx and significantly comprised the airways. Surgery was planned to approach the deeper lobe of parotid gland and para-pharyngeal mass by transparotid, transmandibular swing approach. Histopathological examination revealed the features suggestive of pleomorphic adenoma. The patient was discharged after 9 days with no facial nerve deficit. Management of these tumors is more challenging due to the anatomical location of the para-pharyngeal space. Preoperative definitive diagnosis, with tumor typing, is less important, and incisional biopsy of any PPS mass should definitely be avoided, in order not to run the risk of a significantly higher rate of recurrence.

A rare case report of giant de novo cervical cystic hygroma in an elderly patient: Case report.

INTRODUCTION AND IMPORTANCE: Cystic hygroma is an aberrant proliferation of lymphatic vessels resulting from abnormal development of the lymphatic system.Cervical lymphangioma is an uncommon entity, usually reported in children, rarely in adult. CASE PRESENTATION: Our case presents a 65-year-old man with an extremely huge right-sided painless cervical swelling since 8 years with no symptoms. CLINICAL DISCUSSION: Computer tomography (CT) showed a cystic lesion with thin walls of 150 × 100mm, medial to right sternocleidomastoid muscle (SCM).The lesion was completely resected along with the entire capsule.Post-operatively, the patient recovered well with no signs of any neurological dysfunction and he was discharged from hospital after 2 days. CONCLUSION: The etiology in the adult population is controversial.Diagnosis in adults is considered to present a greater challenge than in children, and final diagnosis is usually based on postoperative histology.Cystic hygroma should be considered as a differential diagnosis of cervical masses in adults.

A case of superior mesenteric artery syndrome got physicians in trouble.

Superior mesenteric artery (SMA) syndrome is a gastrovascular disorder in which the third and final portion of the duodenum is compressed between the abdominal aorta (AA) and the overlying SMA. Our case presents an 11-year-old female with chronic intermittent vomiting that started since she was 6 months old. Contrast enhanced computed tomography scan for abdomen and pelvis guided to the correct diagnosis and the patient received the adequate treatment. Awareness of a broad range of differential diagnosis of vomiting and a high degree of suspicion of SMA syndrome is fundamental in order to direct the proper diagnostic investigation. Duodenojejunostomy provides the best results in severe cases.